Becker A, van der Does F E E, van Hinsbergh V W M, Heine R J, Bouter L M, Stehouwer C D A
Institute for Research in Extramural Medicine, Free University Medical Centre, De Boelelaan 1117, 1008 HV Amsterdam, The Netherlands.
Neth J Med. 2003 Apr;61(4):129-36.
Diabetes mellitus causes a substantial increase in cardiovascular risk, which can only partly be reduced by antihyperglycaemic treatment. We were interested in whether improvement in glycaemic control is associated with improvement of other cardiovascular risk factors. Therefore, we studied among type 2 diabetic patients the association between on the one hand changes in glycaemic control and on the other hand within-subject changes of both classic cardiovascular risk factors and less conventional cardiovascular risk indicators that are typically associated with type 2 diabetes (proinsulin, insulin, fibrinogen, von Willebrand factor and the urinary albumin-creatinine ratio).
The 214 type 2 diabetic patients were randomly assigned to either a strict fasting capillary glucose target level (< 6.5 mmol/l) or a less strict target (< 8.5 mmol/l). Duration of follow-up was two years. Since the interventions did not yield statistically significant differences between the treatment arms, we reanalysed the data focusing on within-subject changes of cardiovascular risk factors and indicators across tertiles of average HbA(1c).
Individuals in whom HbA(1c) decreased had significant favourable concurrent changes in triglycerides, total cholesterol, blood pressure, and in the albumin-creatinine ratio in those who were normoalbuminuric at baseline. In contrast, these individuals had unfavourable, although not statistically significant, changes in HDL cholesterol, proinsulin, insulin, fibrinogen and von Willebrand factor. In the whole group, fibrinogen increased more than could be expected on the basis of the relationship between fibrinogen and age, namely from 3.5 +/- 0.8 to 3.9 +/- 0.9 g/l (p value < 0.01).
Our results suggest that improvement in glycaemia in type 2 diabetes is associated with significant favourable changes in triglycerides, total cholesterol, blood pressure and, in normoalbuminuric individuals, albumin-creatinine ratio. In contrast, it is not consistently associated with favourable changes in some cardiovascular risk indicators typically associated with diabetes, which may in part explain why antihyperglycaemic treatment does not clearly lower atherothrombotic disease risk.
糖尿病会显著增加心血管疾病风险，而抗高血糖治疗只能部分降低这种风险。我们想了解血糖控制的改善是否与其他心血管危险因素的改善相关。因此，我们在2型糖尿病患者中研究了一方面血糖控制的变化与另一方面经典心血管危险因素以及通常与2型糖尿病相关的不太传统的心血管风险指标（胰岛素原、胰岛素、纤维蛋白原、血管性血友病因子和尿白蛋白-肌酐比值）的个体内变化之间的关联。
214名2型糖尿病患者被随机分配至严格的空腹毛细血管血糖目标水平（<6.5 mmol/L）或不太严格的目标水平（<8.5 mmol/L）。随访期为两年。由于干预措施在各治疗组之间未产生统计学上的显著差异，我们重新分析数据，重点关注平均糖化血红蛋白（HbA1c）三分位数范围内心血管危险因素和指标的个体内变化。
糖化血红蛋白降低的个体，甘油三酯、总胆固醇、血压以及基线时尿白蛋白正常的个体的白蛋白-肌酐比值有显著的同时改善。相比之下，这些个体的高密度脂蛋白胆固醇、胰岛素原、胰岛素、纤维蛋白原和血管性血友病因子有不利变化，尽管无统计学意义。在整个组中，纤维蛋白原的增加超过了基于纤维蛋白原与年龄关系所预期的增加量，即从3.5±0.8增至3.9±0.9 g/L（p值<0.01）。
我们的结果表明，2型糖尿病患者血糖改善与甘油三酯、总胆固醇、血压以及尿白蛋白正常个体的白蛋白-肌酐比值的显著有利变化相关。相比之下，它与一些通常与糖尿病相关的心血管风险指标的有利变化并不一致相关，这可能部分解释了为何抗高血糖治疗不能明显降低动脉粥样血栓形成疾病风险。
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